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Alcoholic Cardiomyopathy

Alcoholic Cardiomyopathy

I had a patient the other day who came in intoxicated and tried to "school" me on the benefits of alcohol. Yes, there are some potential heart-healthy benefits of moderate alcohol consumption: Moderate consumption may increase a patient's HDL cholesterol and decrease the rate of blood clotting (acting as an anticoagulant). Yet, drinking too much alcohol can also lead to many negative cardiovascular complications. One such concern related to alcohol consumption is the development of dilated cardiomyopathy. Alcoholic cardiomyopathy (AC) is a form of acquired dilated cardiomyopathy caused by long-term heavy alcohol consumption.

The diagnosis of AC is typically based on patients demonstrating all three of the following criteria:

  • Long-term heavy alcohol consumption (commonly defined as >80 g per day over a period of ≥5 years). This equates to approximately one liter of wine, eight regular sized beers, or one-half pint of hard liquor daily.
  • Features of dilated cardiomyopathy (left ventricular dilation and reduced left ventricle ejection fraction)
  • Absence of other etiologies of dilated cardiomyopathy

The occurrence of AC does not vary much between men and women with alcoholism. However, the burden of disease is higher in men: Hospital admission related to AC occurs with a ratio of nearly 9:1 for men and women, respectively. Adults aged 45 to 59 years are most commonly affected. Symptoms of AC may develop inconspicuously, although some patients may develop acute symptoms of left-sided heart failure.

Other symptoms that may be seen in patients with AC include:

  • Dyspnea, orthopnea, and paroxysmal nocturnal disease
  • Edema of the legs, feet, and ankles
  • Fatigue
  • Weakness
  • Dizziness/vertigo
  • Anorexia
  • Trouble concentrating
  • Paroxysmal atrial arrhythmias (eg, atrial fibrillation)
  • Productive cough that produces a frothy, pink mucus
  • A change in urine output

EKG findings include:

  • Atrial fibrillation (most commonly seen)
  • A prolonged corrected QT (QTc) interval
  • A prolonged QRS duration (which is an adverse prognostic indicator)
  • Left bundle branch block or other intraventricular conduction delay
  • ST and T wave changes

The treatment of alcoholic cardiomyopathy includes correcting any nutritional deficiencies noted. Vitamin supplementation with an intravenous "banana bag" is an important adjunct, particularly in chronic/sustained/heavy alcohol use. Electrolyte disturbances including hypokalemia, hyponatremia, and hypomagnesemia should also be monitored and corrected. If the patient demonstrates overt heart failure, treatment generally includes a combination of a diuretic, beta blocker, ACE inhibitor, angiotensin blocker-neprilysin inhibitor, or angiotensin II receptor blocker per standard guidelines. Arrhythmias should be treated according to standard recommendations. After all the above has been completed, the accepted standard of care for these individuals is total and perpetual abstinence from alcohol consumption.

References
  • Gonçalves A, Claggett B, Jhund PS, et al. Alcohol consumption and risk of heart failure: the Atherosclerosis Risk in Communities Study. Eur Heart J. 2015;36:939-945.
  • Ram P, Lo KB, Shah M, et al. National trends in hospitalizations and outcomes in patients with alcoholic cardiomyopathy. Clin Cardiol. 2018;41:1423-1429.

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Filed under: Cardiometabolic, Substance Abuse

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